Interventions associated with motivational interviewing for antiretroviral adherence by people with HIV

Lima, Maria Amanda Correia; Cunha, Gilmara Holanda da; Fontenele, Marina Soares Monteiro; Siqueira, Larissa Rodrigues; Ramalho, Ane Kelly Lima; Moreira, Lavna Albuquerque; Dantas, Maiara Bezerra; Gomes, Maria Elisa Curado

doi:10.37689/acta-ape/2023AR017122

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Review Article • Acta Paul Enferm 36 • 2023 • https://doi.org/10.37689/acta-ape/2023AR017122 copy

Interventions associated with motivational interviewing for antiretroviral adherence by people with HIV

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze scientific productions about the effectiveness of interventions using motivational interviewing for adherence to antiretroviral therapy by people with the human immunodeficiency virus.

Methods

This is a systematic review carried out in four databases, MEDLINE, CINAHL, IBECS, LILACS, and in an electronic library, SciELO, without language, date and sample size restrictions. The survey of articles was carried out in September 2021, using the descriptors Motivational Interviewing, HIV, Acquired Immunodeficiency Syndrome and Antiretroviral Therapy, Highly Active. Randomized clinical trial articles were included, with a sample of people with human immunodeficiency virus over 18 years old, and research involving children, adolescents and pregnant women was excluded. Ten articles were selected and analyzed regarding the rigor and characteristics of each study.

Results

Motivational interviewing was applied in person and associated with a telephone call, home visit, audio tapes, informational inserts, counseling, cognitive-behavioral and cognitive-social theories. The studies included in this review showed that interventions using motivational interviewing increased adherence to antiretrovirals by people with human immunodeficiency virus.

Conclusion

The study contributed to identify existing data on the effectiveness of interventions with motivational interviewing, focusing on adherence to antiretroviral therapy by people with human immunodeficiency virus, making visible the points that need to be deepened and showing the importance of this strategy, which can be used by nurses and other health professionals, aiming at patients’ well-being.International Prospective Register Systematic Reviews: CRD42019123724

HIV; Acquired immunodeficiency syndrome; Antiretroviral therapy, highly active; Motivational interviewing; Health promotion

Title	Year of publication	Country where the research was carried out
Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study(²¹21. DiIorio C, McCarty F, Resnicow K, McDonnell Holstad M, Soet J, Yeager K, et al. Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study. AIDS Care. 2008;20(3):273–83.)	2008	United States
A randomized controlled trial examining the efﬁcacy of motivational counseling with observed therapy for antiretroviral therapy adherence(²²22. Goggin K, Gerkovich MM, Williams KB, Banderas JW, Catley D, Berkley-Patton J, et al. A randomized controlled trial examining the efficacy of motivational counseling with observed therapy for antiretroviral therapy adherence. AIDS Behav. 2013;17(6):1992–2001.)	2013	United States
A 2-arm, randomized, controlled trial of a motivational interviewing-based intervention to improve adherence to antiretroviral therapy (ART) among patients failing or initiating ART(²³23. Golin CE, Earp J, Tien HC, Stewart P, Porter C, Howie L. A 2-arm, randomized, controlled trial of a motivational interviewing-based intervention to improve adherence to antiretroviral therapy (ART) among patients failing or initiating ART. J Acquir Immune Defic Syndr. 2006;42(1):42–51.)	2006	United States
Group motivational interviewing to promote adherence to antiretroviral medications and risk reduction behaviors in HIV infected women(²⁴24. Holstad MM, DiIorio C, Kelley ME, Resnicow K, Sharma S. Group motivational interviewing to promote adherence to antiretroviral medications and risk reduction behaviors in HIV infected women. AIDS Behav. 2011;15(5):885–96.)	2011	United States
Testing the efficacy of combined motivational interviewing and cognitive behavioral skills training to reduce methamphetamine use and improve HIV medication adherence among HIVpositive gay and bisexual men(²⁵25. Parsons JT, John SA, Millar BM, Starks TJ. Testing the efficacy of combined motivational interviewing and cognitive behavioral skills training to reduce methamphetamine use and improve HIV medication adherence among HIV-positive gay and bisexual men. AIDS Behav. 2018;22(8):2674–86.)	2018	United States
Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial(²⁶26. Parsons JT, Golub SA, Rosof E, Holder C. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial. J Acquir Immune Defic Syndr. 2007;46(4):443–50.)	2007	United States
Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring(²⁷27. Safren SA, Otto MW, Worth JL, Salomon E, Johnson W, Mayer K, et al. Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. Behav Res Ther. 2001;39(10):1151–62.)	2001	United States
Motivational interviewing to support antirretroviral therapy adherence: the role of quality counseling(²⁸28. Thrasher AD, Golin CE, Earp JA, Tien H, Porter C, Howie L. Motivational interviewing to support antiretroviral therapy adherence: the role of quality counseling. Patient Educ Couns. 2006;62(1):64–71.)	2005	United States
A behavioral adherence intervention improves rates of viral suppression among adherence-challenged people living with HIV in South India(²⁹29. Ekstrand ML, Heylen E, Pereira M, D’Souza J, Nair S, Mazur A, et al. A behavioral adherence intervention improves rates of viral suppression among adherence-challenged people living with HIV in South India. AIDS Behav. 2020;24(7):2195–205.)	2020	United States
Effects of motivational interviewing or an educational video on knowledge about HIV/aids, health beliefs and antiretroviral medication adherence among adult thais with HIV/aids(³⁰30. Maneesriwongul W, Prajanket OO, Saengcharnchai P. Effects of motivational interviewing or an educational video on knowledge about HIV/aids, health beliefs and antiretroviral medication adherence among adult thais with HIV/aids. Pac Rim Int J Nurs Res Thail. 2012;16(2):124–37.)	2012	Thailand

Studies	19	20	21	22	23	24	25	26	27	28
Risk of bias
Randomization process	+	?	?	+	+	+	?	-	?	?
Deviation from intended interventions	+	+	+	+	+	+	+	+	+	+
Missing results data	+	?	+	+	+	+	-	?	+	+
Measurement of results	?	+	+	+	+	+	+	+	?	+
Selection of reported results	+	+	+	-	-	?	+	?	?	+
Other biases	+	+	+	+	+	+	+	+	+	+

Title	Objectives	Sample	Intervention group	Control group	Outcomes	Study biases according to RoB 2.0(¹⁸18. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898.)
Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study(²¹21. DiIorio C, McCarty F, Resnicow K, McDonnell Holstad M, Soet J, Yeager K, et al. Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study. AIDS Care. 2008;20(3):273–83.)	Assess MI^* to improve adherence to ART^† in people with HIV.	Total: 247 IG^‡: 125 CG^§: 122	face-to-face MI^* applied by a nurse in 5 sessions, lasting 20-90 minutes, for three months.	Institutional standard care	IG^‡ was superior to CG^§ in adherence to ART^† after 6 months after intervention began (p<0.001).	- Most of the sample consisted of low-income African-American men, preventing generalization of results; - Patients without low adherence to ART were included^†; - Difficulty for patients to adhere to the pill counting technology, which was a device attached to the lid of the medicine bottle.
A randomized controlled trial examining the efﬁcacy of motivational counseling with observed therapy for antiretroviral therapy adherence(²²22. Goggin K, Gerkovich MM, Williams KB, Banderas JW, Catley D, Berkley-Patton J, et al. A randomized controlled trial examining the efficacy of motivational counseling with observed therapy for antiretroviral therapy adherence. AIDS Behav. 2013;17(6):1992–2001.)	Assess MI^* associated with home visits to improve adherence to ART^† in people with HIV.	Total: 204 IG^‡: 69 CG^§1: 70 CG^§2: 65	Association offace-to-face MI^*, home visit and telephone call: 6 face-to-face and 4 sessions by phone, lasting 25 minutes, in 48 weeks. Daily home visits up to 12^to weeks, decreasing with time the frequency, with completion at week 24.	CG^§1: Face-to-face MI^*. CG2: institutional standard care.	IG^‡ was higher than CG^§1 and CG^§2 until week 12 to improve ART^† (p=0.058).	- Patients without low adherence to ART were included^†;
A 2-arm, randomized, controlled trial of a motivational interviewing-based intervention to improve adherence to antiretroviral therapy (ART) among patients failing or initiating ART(²³23. Golin CE, Earp J, Tien HC, Stewart P, Porter C, Howie L. A 2-arm, randomized, controlled trial of a motivational interviewing-based intervention to improve adherence to antiretroviral therapy (ART) among patients failing or initiating ART. J Acquir Immune Defic Syndr. 2006;42(1):42–51.)	Assess MI^* to improve adherence to ART^† in people with HIV.	Total: 155 IG^‡: 77 CG^§: 78	Face-to-face MI^* associated with audio tapes and informative inserts, in 4 sessions, for 14 weeks.	Educational strategy through the provision of information.	IG^‡ was 2.75 times more likely to achieve more than 95% of ART adherence^† than CG^§ (p=0.045).	- High level of refusal to participate in the study, reducing sample representativeness.
Group motivational interviewing to promote adherence to antiretroviral medications and risk reduction behaviors in HIV infected women(²⁴24. Holstad MM, DiIorio C, Kelley ME, Resnicow K, Sharma S. Group motivational interviewing to promote adherence to antiretroviral medications and risk reduction behaviors in HIV infected women. AIDS Behav. 2011;15(5):885–96.)	Assess MI^* to improve adherence to ART^† in people with HIV.	Total: 203 IG^‡: 104 CG^§: 103	Face-to-face MI^* in group, applied by a nurse, in 8 sessions, lasting 1.5-2.0 hours for 9 months.	Educational strategy with lectures, debates, games and educational materials.	IG^‡ superior to CG^§ in ART adherence^† up to three months after intervention began (p=0.04).	- Most of the sample consisted of low-income African-American women, preventing generalization of results; - Patients without low adherence to ART were included^†; - Difficulty for patients to adhere to the pill counting technology, which was a device attached to the lid of the medicine bottle.
Testing the efficacy of combined motivational interviewing and cognitive behavioral skills training to reduce methamphetamine use and improve HIV medication adherence among HIVpositive gay and bisexual men(²⁵25. Parsons JT, John SA, Millar BM, Starks TJ. Testing the efficacy of combined motivational interviewing and cognitive behavioral skills training to reduce methamphetamine use and improve HIV medication adherence among HIV-positive gay and bisexual men. AIDS Behav. 2018;22(8):2674–86.)	Assess MI associated with cognitive behavioral techniques in reducing drug use and improving adherence to ART^† in people with HIV.	Total: 216 IG^‡: 107 CG^§: 109	Face-to-face MI^* associated with cognitive behavioral techniques, in 8 sessions lasting one hour.	Educational strategy with lectures.	IG ^‡ and CG ^§ had improvement in adherence to ART ^† (p<0.01).	- ART adherence measurement^† was self-reported.
Motivational interviewing and cognitive-behavioral intervention to improve hiv medication adherence among hazardous drinkers: a randomized controlled trial(²⁶26. Parsons JT, Golub SA, Rosof E, Holder C. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial. J Acquir Immune Defic Syndr. 2007;46(4):443–50.)	Assess MI associated with cognitive behavioral techniques in reducing drug use and improving adherence to ART^† in people with HIV.	Total: 143 IG^‡: 65 CG^§: 78	Face-to-face MI^* associated with cognitive behavioral techniques, in 8 sessions, during 12 weeks.	Educational strategy using lectures.	IG^‡ was superior to CG^§ in relation to improvement in ART^† (p<0.001).	- Patients without low adherence to ART were included^†; - ART^† adherence measurement was self-reported.
Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring(²⁷27. Safren SA, Otto MW, Worth JL, Salomon E, Johnson W, Mayer K, et al. Two strategies to increase adherence to HIV antiretroviral medication: life-steps and medication monitoring. Behav Res Ther. 2001;39(10):1151–62.)	Assess MI associated with cognitive behavioral techniques in reducing drug use and improving adherence to ART^† in people with HIV.	Total: 56 IG^‡: 30 CG^§: 26	Face-to-face MI^* associated with cognitive behavioral techniques in one session.	Self-monitoring through a diary to record drug intake.	IG^‡ was superior to CG^§ in relation to improvement in ART^†. (p<0.001).	- ART adherence measurement^† was self-reported.
Motivational interviewing to support antirretroviral therapy adherence: the role of quality counseling(²⁸28. Thrasher AD, Golin CE, Earp JA, Tien H, Porter C, Howie L. Motivational interviewing to support antiretroviral therapy adherence: the role of quality counseling. Patient Educ Couns. 2006;62(1):64–71.)	Assess MI associated with social cognitive behavioral techniques in reducing drug use and improving adherence to ART^† in people with HIV.	IG^‡: 47 CG^§: not reported.	Face-to-face MI^* associated with social cognitive techniques, in 4 sessions, lasting 30 minutes, in 12 weeks.	Educational strategy through the provision of information.	IG^‡ was superior to CG^§ for improvement of adherence to ART^†, when patient only considered ART^† as central subject in MI^* (p=0.04).	- Does not report the number of CG ^§ participants.
A behavioral adherence intervention improves rates of viral suppression among adherence-challenged people living with HIV in South India(²⁹29. Ekstrand ML, Heylen E, Pereira M, D’Souza J, Nair S, Mazur A, et al. A behavioral adherence intervention improves rates of viral suppression among adherence-challenged people living with HIV in South India. AIDS Behav. 2020;24(7):2195–205.)	Assess MI associated with social cognitive theory in reducing drug use and improving adherence to ART^† in people with HIV.	Total: 496 IG^‡: 240 CG^§: 256	Ten group support sessions on adherence to ART, lasting two hours, and six individual sessions of 30 minutes using MI.	Institutional standard care and four group sessions, lasting one hour, with themes not related to adherence to ART^†.	IG^‡ superior to CG^§ in relation to ART^† (p=0.017) and viral suppression (p=0.017), one year after the intervention.	- A significant number of participants from key populations, such as sex workers and men who have sex with men, were not recruited, which prevents generalization of results.
Effects of motivational interviewing or an educational video on knowledge about HIV/aids, health beliefs and antiretroviral medication adherence among adult thais with HIV/aids(³⁰30. Maneesriwongul W, Prajanket OO, Saengcharnchai P. Effects of motivational interviewing or an educational video on knowledge about HIV/aids, health beliefs and antiretroviral medication adherence among adult thais with HIV/aids. Pac Rim Int J Nurs Res Thail. 2012;16(2):124–37.)	Assess MI^* with counseling to improve adherence to ART^†, knowledge about HIV and health beliefs in people with HIV.	Total: 90 IG^‡: 30 CG^§1: 30 CG^§2: 30	Association between face-to-face MI^*, phone calls and counseling, in two face-to-face sessions and one over the phone, lasting 25 to 40 minutes, over 4 weeks.	CG1^§: educational video. CG2^§: institutional standard care.	IG^‡ and CG^§1 were superior to CG^§2 in relation to improvement of adherence to ART† (p=0.026).	- ART adherence measurement^† was self-reported.

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[1] Corresponding author: Gilmara Holanda da Cunha E-mail:gilmaraholandaufc@yahoo.com.br